Recently, I was contacted by a nurse practitioner at a local pediatrics office. The practice was looking to begin routinely screening mothers of infant patients for postpartum depression, and they asked for some insight into what is best practice with regards to followup care for women who screen positive for postpartum depression. As somebody who is very passionate about making people more aware of perinatal mood and anxiety disorders (PMADs), I was thrilled to hear that another group of pediatricians had recognized the valuable role they can play in screening women for postpartum issues, which can include:
- Perinatal depression
- Obsessions and compulsions (OCD)
- Posttraumatic stress (PTSD)
Here, I share my advice, along with some valuable information, in hopes of spreading awareness and inspiring other professionals to become involved in the effort to better screen for and support women with PMADs.
The Importance of Screening for PMADs
PMADs occur in 1 out of 5 women during pregnancy and 1 out of 7 women postpartum. Over 86% of women with PMADs may be undiagnosed. These statistics indicate how vital it is for society to become better equipped at understanding these issues, and ultimately, screening for and helping families who are impacted.
I have been a mental health practitioner for more than a decade; yet, prior to my own experience and specialized training in perinatal mental health, I didn’t realize postpartum diagnoses encompassed more than just postpartum depression and psychosis. Most medical and mental health training involves very minimal education on perinatal mental health issues. Thus, many providers aren’t well-informed regarding these diagnoses and may not understand the importance in screening for and treating them.
But postpartum issues are common, and it’s critical for providers to become more aware and understand women can struggle with symptoms that are more than just adjusting to the stress and newness of an expanded family. All professionals who work with new parents need to have these issues on their radar and be equipped to point families in the right direction to get help.
What's the Current Standard for PMAD Screening?
Typically, new moms are screened for postpartum depression by their OBGYNs at their six-week postpartum appointment. (A shout out to all the OBGYNs who are routinely screening their patients!) The problem is that the six-week postpartum visit is sometimes the only time a woman is screened, and OBGYNs may miss the whole population of women whose symptoms develop after that six-week period. (As was my case when I started experiencing postpartum anxiety around 7 to 10 weeks.)
Pediatricians and lactation consultants especially are in a unique position to catch perinatal mood disorders over an expanded period of time, as they typically see women more often due to frequent newborn appointments during the child’s first year. Pediatric practices that understand the importance of screening moms often administer the Edinburgh Postnatal Depression Scale at the one-month, three-month, and six-month newborn appointments.
The Edinburgh is one of the most widely used measures for quickly screening new moms. It is a nice first step; however, it does have some flaws. It screens mainly for postpartum depression but fails to assess for a number of symptoms associated with postpartum anxiety, OCD, PTSD, bipolar, and psychosis. Further, it’s very easy for women to lie or underrepresent their symptoms, possibly fearing they will be viewed as unfit mothers.
How Can Screening for PMADs Improve?
I knew I was feeling off when I completed the Edinburgh scale in my child’s pediatrician’s office; however, I wasn’t depressed. I was happy, I was able to laugh, I was enjoying life. But I was scattered, often felt confused by simple decisions, and was obsessing over silly things. It didn’t occur to me, initially, that what I was experiencing was a postpartum disorder. Because the Edinburgh questions didn’t encompass any of my symptoms, it actually made me think, “I must just be struggling with the adjustment and challenges of two kids versus one.”
Given the shortcomings of the Edinburgh, it is important for providers to also verbally assess how parents are doing and to be aware of the various symptoms and issues that can occur. I encourage nurses and doctors to directly ask parents how they are feeling and how things have been going at home.
Pediatric appointments are focused on the baby as the patient, so monitoring the baby’s health and development is the priority. But the mental health of caregivers is vital to ensuring children have the best environment to thrive. Pediatric appointments are focused on the baby as the patient, so monitoring the baby’s health and development is the priority. But the mental health of caregivers is vital to ensuring children have the best environment to thrive. A simple question such as, “How are you doing? Any overwhelming sadness, stress, irritability, or scary thoughts you’ve had since the baby was born/since we saw you last?” can provide a lot of information. It gives providers the opportunity to assess parents’ reactions—body language and facial expressions as well as verbal responses can go a long way in communicating a struggle.
PMADs Screening Tips for Professionals
If parents do reveal problems, or the Edinburgh results in a positive screen (above a score of 10 or any suicidal thoughts indicated on question #10), it’s imperative that the symptoms be addressed and that providers take responsibility for educating patients, providing referrals, and reassuring them that what they are experiencing is easily treatable.
You can say something like, “It’s common for moms to experience all kinds of hormonal shifts after giving birth, and sometimes, they can cause mood or anxiety issues. They are very treatable, and we can give you some resources to help you get back to feeling like yourself again.” It’s also good to know that 1 in 10 dads experience postpartum depression, so paying attention to the whole family is important.
Taking care of a baby is hard enough without also having to juggle challenging symptoms and feelings that are treatable. Parents need to hear they are not alone, their symptoms are not their fault, and that with help, they can feel better. Providers need to be equipped to recognize the problem and advocate for getting help. To find a mental health professional in your area, start here.
Gunyon-Meyer, B., Cole, J., Tremayne, L, & Standeven, L. (2018). Perinatal mood disorders: Components of care [Training manual]. Retrieved from Postpartum Support International 2-Day Perinatal Mood and Anxiety Disorders Training.